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Assessment, Eligibility and Support Planning

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Disability Rights UK Factsheet F48

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The Care Quality Commission (CQC) have recently launched their new ‘Tell Us About Your Care’ partnerships with a number of national charities, of which Disability Rights UK is one. This involves Disability Rights UK gathering feedback from disabled people about their experiences of using health and social care services. The CQC would welcome feedback on your experience of using any of the services they regulate. Please click here to do so.

Local Authorities’ responsibility under the Care Act

Introduction

Under the Care Act 2014 (that came into force in April 2015), local authorities are now legally obliged to fulfil their duties of care and support for adults. Local authorities are required to ensure that your independence and well being are promoted and that you are given the relevant information to make decisions about your care and support.

In taking on this role, local authorities need to establish whether you are entitled to public care and support. To work out this entitlement in the care and support system, you will need to go through the process of a person centred assessment to enable your local authority to decide whether your needs are eligible (using an eligibility framework) and whether you are entitled to care and support arranged by the local authority. Eligible needs are needs that are determined after an assessment. The next step is to involve you to produce a care and support plan whereby you decide how you wish your care and support needs to be met.

The assessment process in the Care Act

The assessment will be conducted by a social worker/care manager/duty care manager or trained assessor. The assessor should receive the appropriate training as they are also required to carry out complex assessments for those with complex needs. The assessor may also look at the wider needs of the family of the individual if applicable in case there is a young carer. The assessment is meant to be appropriate and proportionate in that you have as much contact with the local authority as you need.

The regulations in the Care Act state that the assessment:

  • is carried out on any adult who appears to need care and support, regardless of their finances,
  • must be offered to any individual which the local authority thinks their needs will be eligible
  • must be conducted by involving the adult and, if required, their carer, or nominee such as an independent advocate
  • must be built on the individual’s needs, their impact on their well being and the desired outcomes that the individual wishes to achieve

Self-Assessment

You can have more control in taking the lead in identifying your needs and outcomes by filling in a Self-Assessment Questionnaire (SAQ) provided you request it and agrees to it. The assessor will still need to approve it and ensure that you have stated the range of all your needs.

Preparing for your assessment

The assessment is a crucial process to get to know your needs and goals to enable your local council to decide whether you require care and support. Local authorities have different assessment formats so there is not a standard form. In the assessment you need to identify the areas that you need help with. Everyone’s situation and needs are different, different things suit different people.

You need to think carefully about what you require assistance with in your day to day life. Hence, you should be fully prepared to give a full picture of the range of your care and support needs. You can request social services to send you a copy of a blank assessment form so that you familiarize yourself with the questions that the allocated social worker will ask you at the meeting. You could ask a family member, friend, or an advocate (please see our factsheet 39 on advocacy) to be present at the meeting to assist you.

You will need to show your social worker what assistance you require. You should think about your needs prior to the assessment. You can keep a diary for a week or more before the assessment where you note down your daily needs and the difficulties you encounter in carrying out the personal tasks and daily activities.  This helps you to keep a record of what you do, how long it takes, and what help you receive, as well as what you would like to be able to do if you had the necessary help. This could give you an overall idea of the things you need support with. It will help you if you have an accurate and comprehensive description of what you need and want support for. Additionally, you need to explain to the social worker any risk to you if your other needs are not addressed. Also do highlight to social services the potential risks and the resulting impact on you not getting the support that you actually need.  Do not pretend to them that you do not need assistance when you actually do. You need to think about the fact that things might take longer on difficult days.

In your preparation, you need to focus on:

  • What sort of help you feel you need
  • How your disability/health condition is affecting you
  • How your care and support needs will best be met
  • What is not working at the moment in your life
  • How you wish to lead and have more control over your life
  • Whether your needs fluctuate due to your health condition
  • Whether you have bad days when your needs are higher than usual
  • How often and how much assistance you require
  • What you want to do if you had support to let you do it
  • What goals you wish to achieve

Some of the areas you may need assistance with to enable you to do things the way you would like are:

  • Getting in or out of bed / making or changing bed
  • Bathing or showering
  • Toileting assistance/washing/dressing
  • Pursuing outdoor day, leisure or educational activities such as joining in local community activities or attending day centres
  • Shopping
  • Respite care or short stay in care home
  • Equipment/aids
  • Meal preparation
  • Laundry
  • General cleaning
  • Socialising and maintaining relationships
  • Going to meetings/events/places of worship

Eligibility

Following the assessment, your local authority must decide whether you are eligible for care and support as per the national minimum threshold for eligibility stated in the Care Act.

With the introduction of the Care Act 2014 that came into force in April 2015, there is a new single national system of eligibility threshold for adults with care and support needs across the country – ending the postcode lottery for social care.

This minimum eligibility threshold is one of the biggest changes in the social care system as all local authorities will now have to follow by law a set of criteria stated in the regulations to secure care provision to disabled people. Prior to this, it was left to the local authorities to set their own eligibility criteria themselves which varied from one local authority to another.

The Care Act is related to the adult social care. Social care covers the range of care and support services that enable disabled people to remain independent and safe and be active, in order to be an integral part of the community. 

The Care Act has emphasized the local authorities’ duties in assessing disabled people’s needs and their eligibility for publicly funded care and support.

With the Care Act in place, it has introduced new responsibilities for local authorities. It has now become mandatory upon local authorities to:

  • conduct an assessment of anyone who requires, or appears to require care and support, including assessing carers, regardless of their eligibility for state-funded care
  • carry out a person centred assessment considering how the needs impact on their well being and the outcomes they wish to achieve
  • produce a care and support plan and to offer personal budget
  • ensure that the person is involved in his assessment, or their carer or any other person they nominate
  • provide information, advice services and access to an independent advocate if required to assist the person in assessment and care planning
  • promote well being when deciding the care and support the person will receive
  • consider other relevant services that can contribute to the desired outcomes for example preventive services, and community support
  • support the development of a diverse range of care and support services via efficient commissioning
  • follow one single national minimum threshold for the determination of eligibility for publicly funded care and support

Although the new long term social care funding system will only be implemented from April 2016, local authorities’ new eligibility criteria for assessing disabled individuals is implemented from April 2015.

Under the Care Act 2014, local authorities need to consider a set of criteria to determine who is entitled to support. Care and support provision could take place at the individual’s home, in a supported living, in a community centre or in a care home.

There are three conditions that must be considered for a person’s needs to be eligible.

First Criteria

The local authority must see whether the person’s needs arise from or are related to physical or mental impairment or illness. This encompasses physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury.

Second Criteria

Resulting from those adult’s needs, local authorities must consider whether the individual is unable to carry out two or more of the outcomes outlined in the regulation of the Care Act. The local authority must take into account the effect of a person’s needs on their ability to achieve two or more of the below listed specified eligibility outcomes:

  • Managing and maintaining nutrition
  • Maintaining personal hygiene
  • Managing toilet needs
  • Being appropriately clothed
  • Being able to make use of the adult’s home safely
  • Maintaining a habitable home environment
  • Developing and maintaining family or other relationships
  • Accessing and engaging in work, training, education or volunteering
  • Making use of necessary facilities or services in the local community including public transport and recreational facilities or services
  • Carrying out any caring responsibilities the adult has for a child

There is no hierarchy to the eligibility outcomes – all are equally vital in the decision-making process of the eligibility determination. When determining the eligibility for care and support, local authorities must assess the adult’s ability to achieve the whole range of outcomes stated in the criteria.

The Care Act regulations outline that ‘being unable to achieve’ outcomes include any circumstances where the person is:

  • unable to achieve the outcome without assistance because for instance the individual needs prompting, or to be reminded of the importance of personal hygiene
  • able to achieve the outcome without assistance but carrying it out causes the adult significant amount of pain, distress or anxiety
  • able to achieve the outcome without assistance, but doing so endangers or is likely to endanger the health or safety of the adult, or of others
  • able to achieve the outcome without assistance but takes significantly longer than would normally be expected, and this may lead to the exhaustion of the individual.

Third Criteria

As a result of being unable to achieve two or more of the above outcomes, local authorities must identify whether and to what extent this impacts on the well being of the individual. The local authority must consider if there is or is likely to be, a significant impact on the adult’s overall well being as a consequence of his inability to carry out two or more of the outcomes.

The term ‘significant’ is understood in its everyday meaning. The impact of needs differ from one individual to another. The way local authorities judge whether there is a significant impact on the well being of the individual should be in the context of what is important to this individual. What is important for this adult’s well being may not be the same in all circumstances. The significant impact on the well being of one person may not have similar effect on another individual in similar circumstances.

To determine this, the local authority look at how the adult’s needs impact on the below areas of well being:

  • personal dignity (also consisting of treating the individual with respect)
  • physical and mental health and emotional well being
  • protection from abuse and neglect
  • control by the person over day-to-day life
  • engaging in work, education, training or recreation
  • social and economic well being
  • domestic, family and personal relationships
  • suitability of living accommodation
  • the adult’s contribution to society.

Care and Support Planning

Once the local authority determines your eligibility for social care funding, a care and support plan will need to be prepared. According to the Care Act, the care and support plan is for ‘meeting needs’, a package that is flexible and creative in focusing on what the adult requires and what they want to achieve. It is a package of care and support that is designed to give you the right level and type of care and support when you need it. It is the core of being in control of your life and budget.

The care and support planning was previously set out in guidance, but it is now recognized in the law asserting the local authority’s legal obligation to give people control over how their needs are met. The local authority will involve you in drafting the care and support plan informing you of the type of support that is available in the community to assist you in making informed choices about your care. Your needs are different from other people, hence they are met in several different ways. Everyone’s support plan will be different because people have different life style.

You are the best judge of your own care and support needs. Self-funders may also benefit from the process of the support planning.

You will be able to state in the care and support planning:

  • What your needs are
  • What changes you want to make about your life
  • What you want to achieve
  • What type of care and support you require
  • How you are going to spend your personal budget to implement changes in your life
  • What services you are going to purchase
  • Any back-up arrangements and emergency support to ensure that you are not left without relevant support when you need it most

Your support plan should meet clear criteria. Local councils should inform disabled people of the help that can get to put together their Support Plan. The length and layout of the support plan may vary from one local authority to another.

The support plan must be agreed and signed off by your local authority in order for the social worker/care manager to release the budget money of your resource allocation. After a period of time, the support plan will be revisited to ensure that your needs are being met.

To write a support plan, you can either:

  • Write it yourself, or
  • Produce it with your social worker/care manager, or
  • Complete it with support from a support broker/independent advocate, or
  • Complete it with the assistance from family and friends.

The personalising care and support planning is considered to be the second step included amongst the ‘Seven steps to being in control of your support’ that have been developed by In Control. These steps guide you on managing your own support:

Step 1: Find out how much money you will get for your support.

Step 2: Produce a support plan that describes how you will spend this money to make changes in your life.

Step 3: You need to have your plan agreed and signed off by your council.

Step 4: Once the plan is agreed, you decide how you wish to manage your budget, for instance, if you want to receive the money as direct payments.

Step 5: You decide how you want to organise your support that best suits your needs.

Step 6: Living your life by purchasing or choosing relevant services from service providers who will support you.

Step 7: You will need to show that you have spent your budget accordingly for your support.

Once you know the amount of money allocated to you, you can then produce your support plan. There are seven important criteria for a support plan, i.e. you will need to answer 7 questions in your support plan to be approved by social services:

1. What is important to you?

Give a description of your lifestyle, hobbies, leisure and interests; and state the people who are important in your life.

2. What do you want to change?

Anything you want to achieve as long as it is realistic. It could be that you want to change services or want to live somewhere else.

3. How will you arrange your support?

You should state what kind of relevant support you want to get to make changes in your life.

4. How will you spend your money?

Decide whether you want to receive the money as direct payments or indirect payments, and how much the support service will cost.

5. How will you manage your support?

You will specify in your plan who is going to manage the budget; and how you will sort out the wages of your personal assistants (PA’s). The plan will take into account employment laws.

6. How will you stay in control?

You will describe the decisions you make to stay in control with or without support.

7. What will you do next? (What are you going to do to make this plan happen?)

This is an action plan. You will mention real and measurable things that will take place in the future.  You will explain in your plan as to who is responsible for each action and the length of time it will take to be accomplished.

Where can I get more help or information?

This factsheet is a basic overview of assessment, eligibility and support planning under the Care Act 2014. You can find out more detailed information about social care and independent living in our Disability Rights Handbook. This and all our other publications are available from our shop at https://www.disabilityrightsuk.org/shop

You can also place orders by contacting Disability Rights UK.

For further help and information please contact our Advice Line - 0330 995 0404.

You can get more information about where to get personal advice from our Factsheet F15 - Getting advice. All our factsheets are free to download on our website at disabilityrightsuk.org. We have a number of independent living factsheets.

2 October 2015

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